Development of Visual Perceptual Skills: Visual Closure

Visual closure is a sub-test on the Test of Visual Perceptual Skills (TVPS) that children tend have a lot of trouble with. As described in my previous post about Visual Perceptual Skills: Real Life Applications, visual closure is a skill that allows a child to see part of a word, shape, or picture, and fill the rest in their head.

First of all, think of how important this skill is for spelling, writing, reading, etc. Actually no, strike that. First think about how difficult this skill is. In fact, if you look at work by Warren (1993), she sees the whole concept of visual processing as a hierarchy, and way up at the top of her model is where you’ll find visual cognition – the skills that we are typically assessing in our evaluations.

So what does that mean? Well, to me, it means hold up for just a moment. If you are scouring the internet for activities related to a specific area of visual perception that a child has a deficit in (i.e. figure ground, visual spatial, visual memory, etc.), don’t just assume that you can throw these activities at them and see all of their functional skills improve. That’s a recipe for splinter skills. (When you can do a very specific task, but it doesn’t generalize beyond that specific task.)

You first need to look deeper into the foundation skills that sit underneath visual perception. Things like acuity, oculomotor control, postural control, attention… and so on. You can’t expect a child to improve their visual perceptual skills when they can’t even sit upright to look at the paper, or can’t dissociate their eye movements from their head, or can’t attend to a visual stimulus for more than a few seconds. You can’t run before you can walk, you shouldn’t put your cart before the horse, and, you know, all of those other helpful sayings that might apply here. This is really true with anything we do in therapy, building the foundation first, but more and more often I see this getting lost when dealing with visual perception.

Ok then, allow me to get off of my foundation skill soap box. Let’s assume you’ve done all of that ground work, maybe made a referral to an optometrist, covered all of your bases, and are truly ready to challenge certain aspects of visual perception. Here are a few ways I’ve seen and used to work on visual closure:

Grid designs: This is a very simplistic way to get started with visual closure skills. Using two grids, the child copies a design from one grid to another. Grade the challenge up or down by changing the number of dots you use, how close the grids are to one another, or maybe even incorporate vestibular/oculomotor work input by placing the model behind or to the side of the child so they have to turn their head or move their eyes in order to complete the task.

As you continue to increase the challenge, you can slowly fade away grid points so the child has to do more work to accurately complete the shape.

This can also be done with more functional designs such as letters or pre-writing shapes.

While on the note of visual closure and forming letters, I want to bring your attention to a commonly used prompt for children. How many letter worksheets do you see with the dots like the picture below? Think of what you are asking the child to do – it falls into the realm of visual closure in order to accurately trace the dot letter. For children that have trouble with this skill, it might not be an effective way to practice and remember letters. If the child isn’t having success remembering letter formations using the dot technique, I’d start with a highlighter for tracing as a way to grade the activity down for more initial success.

Dot to dots: Along the same lines as grid designs, but way less official or potentially intimidating, you can find dot to dot activities in many commercial children’s activity or coloring books.

Stencils: Stencil sets allow you to create an outline of something, and then add on details. The child could trace an animal or a shape, and then add details in order to complete the image.

What number/shape/word is this?: Only showing a portion of a picture or a word. You can do this by writing a word on the marker board, then wiping away a portion of it, or you can cut out a card stock grid that only shows a portion at a time. The best part about doing this on a dry erase marker board is that you can grade how much of the shape or image you choose to wipe away depending on the success of the child.

Finish the picture: Giving the child half of a picture; “pic-art” style would be easiest, as shown below, and a full detailed magazine picture would be the most challenging. Another idea I’ve enjoyed is to start a picture that looks like one thing, but then the child has to change it into something else.

For even more simplicity, you could cover up part of an illustration in an book you are reading together, and see if the child can guess what the whole image is.

A lot of these activities are fairly easy to incorporate into home practice after they are introduced in a session. As with any home program, your therapist should be able to help you find an appropriate starting point for the child, and then grade the activities up as needed.

P.S. Yes, I know there are many apps out there that promote these kinds of skills as well, but I’m going to be that crotchety old therapist that wants to avoid adding any more screen time for a child than they are already getting.

Warren, M (1993), A Hierarchical Model for Evaluation and Treatment of Visual Perceptual Dysfunction in Adult Acquired Brain Injury, Part 1. The American Journal of Occupational Therapy, 47 (1), 42-54.

Sorry for the delay in response. The ability to close in the dotted lines in your head is considered “visual closure.” However, you could argue that there is an element of spatial relationships in there as well. It’s sort of difficult to tease apart some skills!

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-The Anonymous OT’s mission is to provide a place for families and professionals to interact, speak freely, learn important, straightforward information, and share their experiences related to the world of pediatric occupational therapy.

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